OCD Awareness : If The Truth Is Understood, Why To Stop?

Obsessive Compulsive Disorder causes quite an anxiety in those affected. OCD involves both obsessions and compulsions that take a lot of time and energy. It's difficult for the affected to get in the way of important activities the person values.
Obsessive Compulsive Disorder (OCD) may show itself in many different forms with variable degrees of intensity. It is important to be educated on this subject and what actually it constitutes.

About a decade ago, David Adam punctured his barbed wire fence, wounds were not deep, but bleeding. As a science journalist and author of "The Man Who Could not Stop: OCD and the True Story of a Life Lost in Philosophy," (The Perseverance: OCD and the True Story of a Life Lost in Philosophy) The book describes Adam's own course of confrontation with obsessive-compulsive disorder), who is well aware of what may happen. His obsessive-compulsive disorder is manifested as a strong fear of the HIV virus and a series of compulsions about the blood.

New research shows that patients with obsessive-compulsive disorder are not appropriate to determine their behavior fairly well, but their actions are hard to follow.
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He hurried home and took some paper towels back to check that no blood remained on the wire. "I wiped the barbed wire with a paper towel to make sure there was no blood on it, but when I turned around and ready to go back, I repeated the same thing over and over again," said Adam. "You're so deeply stuck in such a dreadful cycle that you Evidence that you can find has been proven there is no blood, and you can answer 'no' wisely when others ask you, but there may still be a little bit in your heart. "

Similar compulsive behavior and its associated obsession are what we call obsessive-compulsive disorder, a far cry from the clean and tidy behavior we normally understand Can destroy a person's life. Adam's story describes an obscure feature of obsessive-compulsive disorder: patients with obsessive-compulsive disorder often are clearly aware that their actions are illogical, but they simply can not stop.

The ocd cycle
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A new study recently published in Neuron offers a possible explanation. Researchers use mathematical simulations of decision-making in a simple game to understand the conflicts that occur in the minds of people with OCD. Often, people use their trust in their surroundings to guide their actions. "If I think it's raining, I'll go out with an umbrella," said lead author Matilde Vaghi. The study shows that for obsessive-compulsive patients, beliefs and actions are somewhat out of touch and as a result lead to behavioral contradictions with their own perceptions. This shows that coercion is a central condition, not just the product of one's obsession or false belief.

This research by Waji and colleagues shows that computational psychiatry is playing a role as a new discipline. Current psychiatrists rely on the observation of clinical symptoms and computational psychiatry, based on biological and cognitive mechanisms to improve diagnostic accuracy, will eventually become a new tool for early diagnosis of patients. A mechanistic-based analysis shows that unreasonable repetition is a common feature of many diseases, such as obsessive-compulsive disorder, substance abuse, or eating disorders. This type of analysis can further identify different types of obsessive-compulsive disorder and provide recommendations for psychiatrist personalization.

In principle, the contradiction between obsessive-compulsive patients' beliefs and actions can be explained in two ways: their ability to perceive the environment is compromised to some degree; or they are cognitively accurate but lack confidence in what they already know.

Separation of action and thought

Inspired by this, Waji and colleagues decided to investigate the relationship between belief and action in the cognitive environment of obsessive-compulsive patients and normal subjects; to organize causal relationships among them and to find out the cause of the patient's problems. The team was led by Fabrice Luyckx, a graduate student at Cambridge University, and Benedetto DeMartino, a neuroeconomist at The University of London and author of the paper, Use reliable tests to study how beliefs and actions evolve in the cognitive process. They recruited 24 obsessive-compulsive patients and 25 healthy volunteers and asked them to play a video game in which the subject had to move the target (a bucket) around in circles to catch the color patches emitted from the center Some coins). The subject must move the bucket to the position where it may receive the next coin and have it assess the reliability of the prediction before the coin is thrown. Most of the time the coins are thrown in almost the same direction, with only a slight change from last time, but a one-eighth chance of major changes.

Game screenshots. Subjects need to place the bucket (yellow arc) somewhere in the circle and then give their confidence score from 1 to 100 on the slider bar below; after the score is finished, the center of the circle will emit a coin Bucket catch will score. The top right corner shows the current accumulated points. The direction of the coin is almost always the same as last time, which gives the participants a basis for judgment.

Coins fall. In the 75 tests, with a 1 in 8 probability, the coin's placement will change drastically (black squares) and the coin's placement will be determined by a Gaussian distribution between the changes. According to the rules of the game, the researcher can establish the mathematical model of the participants' decision-making and simulate how the choice and confidence of the participants change over time.

There was not much difference between the two groups in the success rate of catching coins, but patients with obsessive-compulsive disorder tended to place the barrel precisely on the last coin compared to the control group. Health participants' actions more accurately reflect the expectations of the mathematical model, and OCD patients deviate from this expectation overall. The patient group overreacted to the "predictive error" often referred to by psychiatrists. This "error" is characterized by the placement of the barrel center and the difference in coin placement. The healthy volunteers did not pay too much attention to these errors, and they calculated in the mind the falling points of the coins from the previous trials, averaged, and did not change the position of the bucket too much unless the position of the bucket was away from the coin The average landing distance is too far.

Most critically, there was no significant difference between the two groups, even though the accuracy of the prediction between the two groups (the predictive accuracy dropped sharply as the coin changed direction and rose after several throws) showed that the patient's perception of the environment Normal people are equally accurate, but their actual action on the barrel shows that they do not use this ability to guide their actions. "This study illustrates the separation of action and thinking in patients with obsessive-compulsive disorder," Vaji said. "This is closely related to the patient's clinical presentation. The patient would say, 'I know touching a doorknob is not so dirty as the handle, Even then, I will wash my hands constantly. "

The team also found that when the individual's symptoms worse, cognitive and behavioral separation is also greater. "We find it very exciting to see the importance of belief and action separation in obsessive-compulsive disorder, and the degree of separation between knowing and doing is clearly related to the severity of the symptoms," said D'Martino. This result suggests that compulsive behavior is a central feature of obsessive-compulsive disorder and not merely a manifestation of special obsession (eg, constant hand washing to alleviate contaminated anxiety). "Traditional therapies consider obsessive-compulsive disorders based on specific obsessions that drive people to perform coercive actions to reduce their anxiety," Nathaniel Daw, a computational psychiatrist from Princeton University, who did not participate in the study, However, he believes that "this study supports another view that coercion is itself a core issue rather than a by-product of specific objections."

Obsessive-compulsive disorder beliefs and actions of the separation, and the degree of separation and the severity of the relationship between the disease. The ordinate in Figure A represents the degree to which changes in confidence can be reflected in their actions. If the reduction in confidence is greater, the more buckets move, the more uniform the beliefs and actions and the greater the values. The less conviction and actions the numerical values Small, even negative. Can see the patient group value is smaller. The abscissa of the graph B is the ordinate of the graph A, and the ordinate is the severity of the patient.

De Martino is interested in people's decision-making mechanisms under normal circumstances, especially the relationship between confidence and action. These two are often entangled together, it is difficult to understand the specific relationship, but the research team found that patients with obsessive-compulsive disorder can provide a natural way to separate them. The traditional view that a person's confidence can be measured by action, for example, the length of time before you take action reflects the extent of your confidence is not firm. "You can roughly assess your confidence by looking at your behavior, but this is not the only way your brain works," said D'Martino. If one's confidence is to be assessed by observing his actions, it is difficult to separate the confidence and the actions. In practice, however, the level of confidence may or may not be assessed independently, as both a guide to action and as observable - a form that is much like a "parallel" structure. And this form "is exactly what our numbers show," said D'Martino. "So in addition to its clinical value, the study has universal appeal and these patients can help us to differentiate between different cognitive structures." "

The results of the study show that the assessment of confidence in the brain is independent of action, but the functioning of the brain depends on the close association of confidence and action. This is also compatible with the self-controlled "two-system" theoretical model. The "dual-system" theoretical model refers to a self-control system that makes reasonable actions and an impulsive system that encourages individuals to satisfy their desires. They control behavior separately, saying: "Most of the mental problems concerning obsessive-compulsive behaviors Disconnected or unbalanced. "

It should be noted that this study is only a short period of time for those who already have obsessive-compulsive disease research, it can not clearly distinguish between cause and effect. "What we do not know is the disease caused by this imbalance or the imbalance caused by the disease," said Dao. Identifying the link between general imbalances and patient specific obsessions and coercion requires longer-term observations of obsessive-compulsive patients to study how different aspects of the disease develop over time. However, if cognitively unmatched behavior is indeed at the root of obsessive-compulsive disorder, this will represent a more generalized mechanism of disease that explains a wider spectrum of diseases under different clinical manifestations. "We want to guide new treatments by clarifying the general mechanisms rather than focusing on individual symptoms," said D'Martino. "If current research suggests that compulsive behavior is inherently at the heart of the disease, then direct treatments for behavior modification such as cognitive behavioral therapy may be more effective than therapies that try to correct a patient's persistent circulatory thinking," Vajjay said.

Find the brain mechanism

The team's next plan is to investigate where the underlying mechanism of such damage occurs mainly in the brain. Researchers have known that some obsessive-compulsive patients have abnormal connections between the frontal cortex, which is mainly responsible for the coordination of advanced functions of the brain, such as planning and countermeasures. Some deeper areas are also known, including the ventral striatum (Ventralstriatum) is abnormal. And that "prediction error" that seems to determine abnormal patient behavior is also mainly produced in the ventral striatum. These findings suggest that the neural circuit between the prefrontal and striatal regions may be a potentially critical factor in this type of psychiatric abnormality. The use of brain imaging techniques in this area of ​​obsessive-compulsive patients will be able to verify the correctness of these hypotheses. "Mental disorders are really disorders of the brain," said Vaggi. "Psychiatric studies used to leave a little stigma. For example, we often think mental patients are crazy or think they are nonsense, but we do not think about cancer patients That said, "she added," linking these abnormal behaviors to brain mechanisms may help wash the stigma. "

This study shows the potential for psychiatry computing, said Waghi. "This shows that it is indeed a valid way to combine computer science with clinical aspects, and we can not explicitly point out what these behaviors are related to with the computational model - We can understand which parts of the model explain behavioral problems. "

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References for further reading:

• https://www.scientificamerican.com/article/an-inner-look-into-the-minds-and-brains-of-people-with-ocd1/
• https://www.claremontpractice.co.za/newsletter-1213.html
• http://www.louisvilleocdclinic.com/worry-doubt-ocd.php
• https://www.smartlivingnetwork.com/anxiety/b/the-5-different-types-of-ocd/
• https://www.medicalnewstoday.com/articles/178508.php
• http://www.nationalanxietyfoundation.org/what-is-ocd-.html

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